December 22, 2017
Every day, nearly 120 Americans die of an opioid overdose, according to figures released in December by the National Center for Health Statistics. A new commentary by a UNC Gillings School of Global Public Health alumnus addresses this uncontrolled national emergency.
Nabarun Dasgupta, PhD, senior epidemiologist at UNC’s Injury Prevention Research Center, is lead author of the commentary, “Opioid Crisis: No Easy Fix to Its Social and Economic Determinants,” published online Dec. 21 in the American Journal of Public Health.
“As a first step in addressing the crisis, we must see it as a symptom of deep social, economic and other structural problems in American society that extend back decades,” Dasgupta said. “Opioid prescribing is as much an indicator of Americans’ demand for pain relief, as it is about the supply of opioids.”
Dasgupta also noted that the racial dimensions of pain and addiction have been glossed over.
“This isn’t only a ‘white people’s problem,’ by any means,” he said.
The authors describe over-prescription of analgesics as the health-care system’s search for easy fixes to address complex physical and emotional patient programs. In advancing policies that aim only to curtail the number of prescriptions written, policy makers overlook the factors that drive Americans to use and misuse opioids. These include economic and social upheaval, physical and psychological trauma, concentrated disadvantage, isolation and hopelessness.
“Overreliance on opioid medications is emblematic of a health-care system that incentivizes quick, simplistic answers to complex physical and mental health needs,” they write. “In an analogous way, simplistic measures to cut access to opioids offer illusory solutions to this multidimensional societal challenge.”
The authors trace the trajectory of the opioid crisis through the intertwined use of opioid analgesics, heroin and fentanyl, and urge policy makers and health-care professionals to see the formidable public health emergency through the lens of structural determinants.
“A broad focus on [human] suffering should guide both patient- and community-level interventions,” they write.
Co-authors of the commentary are Leo Beletsky, MPH, JD, with Northeastern University’s School of Law and Bouvé College of Health Sciences, in Boston, and the University of California at San Diego’s School of Medicine, and Daniel Ciccarone, MD, MPH, with the University of California at San Francisco’s Department of Family and Community Medicine.